Dental Insurance-Short and Not so Sweet

Ah, the mystery of dental insurance. Who really understands it? We asked our resident expert, Tabitha, to explain it to us in a nutshell.

When picking an insurance plan, you probably look for the best, cheapest price. Remember, just like other insurance policies, the more you pay, the better the benefits.

First, nearly all dental policies have a maximum amount allowed for treatment per person. Usually, this is between $1000-1500. This maximum is the total amount that the insurance company will authorize payments. Preventive services are generally part of that ceiling. Additionally, there is a deductible-per family member, usually, $50-100. This deductible is the patient’s portion, and most plans exempt preventive services from the deductible. Insurance pays with the deductible and total yearly payment in sight. No company ever spends more than the maximum designated on the plan.

Insurance does not pay for everything. Depending on the plan, preventive pays at 100% of their allowed fee. The insurance payment may not be our full fee so you would be responsible for the difference. If we are participating providers on that plan, you may have nothing to pay because we have agreed to subsidize your care; otherwise, you may have an amount due to us. Fillings usually pay at 80%; crowns and bridges, etc. at 50%.

Insurance denies some services like cosmetic treatments, may not replace teeth before coverage date, have waiting periods for some services, and some policies disallow white fillings in the back of the mouth and might allocate a silver filling fee subsidy. Read the fine print; that’s where they put all the limitations.

If you have trouble finding a plan or don’t want the bother of a maximum or deductible, check out Dr. Bob’s Smile Plan on our website.